09 May 2009

Dr Grumble has signed the Official Secrets Act. More than once. It doesn't actually make any difference whether you sign it or not. In one government department they don't bother. In another they do. Dr Grumble is holding back here. Even that is a secret. Almost anything can be seen as an official secret. You can see the reasons for secrecy - sometimes. But quite often it seems that secrecy is being used to protect somebody. Secrecy over MPs' expense claims could be seen as an example. The taxpayer pays. Why shouldn't the taxpayer know where his money is going?

Another form of secrecy is commercial secrecy. Data submitted for medicines licensing is an example. The results of drug trials are not always in the public domain and the licensing authority cannot release them because of commercial confidentiality. Yet for many of these drugs the taxpayer foots the bulk of the bill. So why shouldn't the taxpayer have access to the data which led to the granting of a product licence? Why shouldn't patients taking medicines have access to all the data upon which the safety and efficacy of the product was judged? They have to take the medicine. They have to suffer the adverse events. They are the ones for whom efficacy matters most. Surely they have a right to see the data? And, of course, the same goes for their doctors. This could be a condition of the licence approval. It would be unlikely to cause commercial damage.

But what has really goaded Grumble into this tirade on secrecy? It wasn't the MPs' expenses. It wasn't even the drug licensing issue. It was frustration that we do not know how much the parts of the NHS that have been privatised are costing. Except that is for one ISTC. You can read about that in an article written by Allyson Pollock.

It's long article. Here's a key bullet point:

The Scottish Regional Treatment Centre treated only 32% of annual contract referrals in the first 13 months of operation at 18% of the annual contract value. If the same patterns apply in England, up to £927m of the £1.5bn may have been paid to ISTCs for patients who did not receive treatment under the wave one ISTC contracts.

Allyson tells it as it is. She can't be much loved in some quarters. She will never be Dame Allyson. Probably she doesn't want to be a dame.

It is mind boggling to think that a consultant physician working within the NHS should ever have to sign the Official Secrets Act.

I am a fan too, and have heard her talk, but sadly Allyson Pollock is a tiny voice in the wilderness. Her excellent BMJ article is technical and will likely be glossed over by the main stream media who will not understand the implications. Meanwhile, NHS expenditure on private enterprise will continue to go unnoticed. For example, who, outside the NHS, really understands the downside of PFI?

And now we hear from the RCN that:

The NHS spent £350m on external management consultants in the last financial year, according to an RCN survey.

According to the Freedom of Information Act survey, obtained from 240 NHS organisations in England, nearly £273m of this was not related to direct patient care. This is a far far bigger scandal than MPs expenses, vulgar and venal though their behaviour has been.

Grumble might get into trouble if he went into detail on why he has signed the Official Secrets Act. As a lawyer, Dr Crippen, you can probably confirm that it does not matter whether or not you have signed the Act you are covered by it anyway. They get you to sign it to highlight the fact that you are required to keep official secrets secret. In other words it is to put the frighteners on you. The trouble is that Dr Grumble's limited understanding of the Act suggests that virtually anything could be construed as an official secret.

Are there things that Grumble knows that he would like to reveal but does not dare? Yes. It's probable the information is already in the public domain but without being sure Dr G is going to keep mum. It is not so much the information that is the problem it is the critical interpretation Dr Grumble would like to put on it that persuades him it is best to stay silent. Doubtless if Dr G were to sing the praises of the government and let a minor secret slip he would get away with it but if he were to be critical it would be asking for trouble.

None of this is healthy. It would be in the public interest to reveal many things that the government likes to keep to itself and the amount paid to private contractors to provide NHS care is one. We all have a good idea of what this would show but mostly we just cannot prove. And Dr G is not in a position to tell you whether he knows any more than that or not.

Bear in mind that the term "secret" is defined in the Act, and it doesn't just mean anything that the government would rather people didn't know: generally only information on defence, certain aspects of law enforcement and international relations. See the Wikipedia article for a summary.